1 - O+G - Hx + Ex - Obstetric Ex Flashcards
4 main parts
general exam
abdo exam
other relevant features
presentation
what happens at the booking visit?
wt, ht, BMI, chest, breasts, CVS, legs examined
BP and urinalysis done together
general examination - parts? what if BP raises
general appearance, temp, oedema, anaemia, ‘booking visit things’, BP
raised OR proteinuria -> examine further eg epigastric tenderness in pre-eclampsia
Abdo exam - pt pos? exposure? when is uterus normally palpable? where is fundus at 20wks? larger than expected uterus before 20 wks due to?
lie semi prone (avoid aortocaval compression)
exposed below breasts to PS
normally palpable at 12-14wks
by 20wks fundus usually at level of umbilicus
incorrect dates, full bladder, multi preg, uterine fibroids, pelvic mass
Abdo exam - inspection?
size of preg uterus, look for striae, linea nigra, and scars esp in supra pubic area
fetal movements visible in late preg
Abdo exam - palpation - purpose? if complaint of pain or antepartum haemorrhage?
fetus growth? fluid volume normal? lie longitudinal? presentation cephalic? if so, has baby engaged?
first step of palpation
measure uterus - from superior border of PS to fundus dip - do it blinded (bias) - cm = age - eg 36 cm = 36 wk gestation (away from this can indicate problem) (+/- 2cm)
called symphysis fundal height
palpation - step 2 and 3
2 - use both hands to palpate down fetus toward pelvis - estimate fluid vol m- find head - identify lie
3 - turn to face pelvis and press fingers of both hands just above PS to assess presentation - usually cephalic - engagement in 1/5ths palpable - >1/2 = engaged
auscultation?
listen over ant shoulder with pinard
use watch for HR - 15seconds
110-160bpm normal
how to present
Mrs X looks (general appearance), her BP is XX and urinalysis shows YYY, her abdo is distended compatible with pregnancy, the SF height is XX and the lie is XXX and presentation is XXX and it is NOT OR x/5ths engaged, fetal heart is audible and XXX bpm. there is ANY OTHER FINDINGS
